[Comparison of ultrasonography with radiography for the detection of cervical esophageal foreign body]

Detection of retained foreign bodies remains a significant problem in the emergency department. Foreign bodies can go undetected causing infectious complications ultrasonography is too inaccessible and expensive. The purpose of this study is comparison of ultrasonography with radiography for the detection of cervical esophageal foreign bodies This cross-sectional study evaluated 58 patients referred with suspected upper esophageal foreign body in the Emergency Department, Amir Alam. Patients were evaluated with ultrasonography and x-ray. After surgical exploration, different type of foreign bodies were recorded. The SPSS statistical software was used for analysis. For applicable efficacy outcome measures, a Spearman correlation was used. Differences were significant when P<0.05. All values were expressed as the frequency and present. Fifty eight patients were studied.25 patients [43.4%] were male and 31 patients [56.9%] were female, in 28 [48.2%] patients foreign bodies were detected in radiography. 30patients [51.8%] were not recorded in techniqe. It was found in patients 22 [78.6%] organic body, and six cases[21.4%] non-organic body. radiographic outcomes in patients with foreign bodies were positive in26 patients [92.9%] and in two patients [7.1%]were negative. Ultrasound results were positive in 27 patients [96.4%] and in one patient [3.6%] were negative. Association of ultrasound and radiography results were significant in patients with foreign body [Spearman correlation=0.896, P=0.001 Kappa=0.890]. These reports suggest that result of ultrasound with radiography for the detection foreign bodies in cervical esophagus have good agreement. The use of ultrasonography in the emergency department to detect and eventually remove foreign bodies by emergency physicians is an important issue because there is not always an ultrasound technologist or radiologist available.

Leukocyte count and erythrocyte sedimentation rate as diagnostic factors in febrile convulsion

Febrile convulsion [FC] is the most common seizure disorder in childhood. white blood cell [WBC] and erythrocyte sedimentation rate [ESR] are commonly measured in FC. Trauma, vomiting and bleeding can also lead to WBC and ESR so the blood tests must carefully be interpreted by the clinician. In this cross sectional study 410 children[163 with FC], aged 6 months to 5 years, admitted to Bahrami Children hospital in the first 48 hours of their febrile disease, either with or without seizure, were evaluated over an 18 months period. Age, sex, temperature; history of vomiting, bleeding or trauma; WBC, ESR and hemoglobin were recorded in all children. There was a significant increase of WBC [P<0.001] in children with FC so we can deduct that leukocytosis encountered in children with FC can be due to convulsion in itself. There was no significant difference regarding ESR [P=0.113] between the two groups. In fact, elevated ESR is a result of underlying pathology. In stable patients who don't have any indication of lumbar puncture, there's no need to assess WBC and ESR as an indicator of underlying infection. If the patient is transferred to pediatric ward and still there's no reason to suspect a bacterial infection, there is no need for WBC test

Is ceftizoxime an appropriate surrogate for amikacin in neonatal sepsis treatment? a randomized clinical trial

Neonatal sepsis, a life-threatening condition, presents with non-specific clinical manifestations and needs immediate empirical antimicrobial therapy. Choosing an appropriate antibiotic regimen covering the most probable pathogens is an important issue. In this study we compared the effectiveness of ceftizoxime and amikacin in the treatment of neonatal sepsis both in combination with ampicillin. In a randomized clinical trial, all term neonates with suspected sepsis referred to Bahrami hospital during March 2008 to March 2010 were evaluated. Patients were randomly recruited into two groups; one group receiving ampicillin and amikacin and the other ampicillin and ceftizoxime. Blood, urine and cerebrospinal fluid cultures, leukocyte count and C-reactive protein level were measured in all neonates. A total of 135 neonates were evaluated, 65 in amikacin group and 70 in ceftizoxime group. 60 neonates [85.7%] in ceftizoxime group and 54 neonates [83.1%] in amikacin group responded to the treatment [P=0.673 and ?2=0.178]. Only 24 [18%] blood samples had a report of positive blood culture. The most frequent pathogen was coagulase negative staphylococcus with the frequency of 58.32% of all positive blood samples. Ceftizoxime in combination with ampicillin is an appropriate antimicrobial regimen for surrogating the combination of ampicillin and amikacin to prevent bacterial resistance against them

Adverse drug reactions; as a cause for admissions to a Children's Hospital

The aim of this study was to investigate the adverse drug reactions [ADR] in pediatrics and determine the predominant symptoms of adverse drug reactions in children. This case series study was carried out at the Bahrami Pediatric Hospital, Tehran where the files of 25 admitted patients with the diagnosis of adverse drug reaction 1998 to 2005 were studied. The average age was 4.6 [ +/- 3.7] years and symptoms of adverse drug reactions were observed 12.6 [ +/- 14.3] days after initiation of the drug intake. Skin rash was seen in all patients more in form of maculopapular rash followed by urticaria. Arthralgia was the next common symptom observed in 44% of patients. The common abnormal laboratory data was high erythrocyte sedimentation rate which was seen in 40% of patients. The most common ingested drugs were phenothiazine and sulfasalazine [each of them seen in 28% of patients] followed by penicillin [16%], furazolidone [16%], cephalosporins [4%] and valproic acid [4%]. In 28% of patients poly-pharmacy was responsible for ADR. Awareness of the problem, observation of poly-pharmacy and potential drug-drug interactions, and continuous re-evaluation of the ongoing individual pharmacotherapy is important, especially in children, to reduce ADRs